Preoperative Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for Prediction of Microvascular Invasion in Small Hepatocellular Carcinoma

Kobayashi, Tomoki; Aikata, Hiroshi; Honda, Fumi; Nakano, Norihito; Nakamura, Yuki; Hatooka, Masahiro; Morio, Kei; Morio, Reona; Fukuhara, Toru; Kitajima, Masaki; Nagaoki, Yuko; Kawaoka, Tomokazu; Tsuge, Masataka; Hiramatsu, Akira; Imamura, Michio; Kawakami, Yoshiiku; Ohdan, Hideki; Awai, Kazuo; Chayama, Kazuaki

doi:10.1097/rct.0000000000000405

Cited by 39 publications

(30 citation statements)

References 32 publications

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“…A radiomics nomogram to predict microvascular invasion risk in HBV-related HCC • 125 In the present study, presence of nonsmooth tumor margins, hypoattenuating halos, and internal arteries was significantly associated with MVI status in the training and validation cohorts, which is in agreement with the results of previous studies (29)(30)(31)(32). A previous study reported radiogenomic venous invasion (RVI), which included internal arteries, hypodense halo, and tumor-liver difference, as a contrast-enhanced CT biomarker for prediction of MVI (13).…”

Section: Discussionsupporting

confidence: 91%

A radiomics nomogram for preoperative prediction of microvascular invasion risk in hepatitis B virus-related hepatocellular carcinoma

Peng

Zhang

et al. 2018

Diagn Interv Radiol

153

124

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H epatocellular carcinoma (HCC) is the sixth most common type of cancer and ranks third as a cause of cancer-related death globally. Worldwide, approximately 630 000 new cases of HCC occur annually, with more than half of these cases occurring in China (1). This disease is related to hepatitis B virus (HBV) infection in almost 70%-90% of cases in the highly endemic Asia-Pacific regions, especially in China (2, 3). Partial hepatectomy and liver transplantation are the most effective curative treatments, albeit in a limited number of cases (4). Indeed, the 5-year recurrence rates after surgical treatment and liver transplantation are as high as 70% and 35%, respectively (5-7). It is, therefore, necessary to find effective biomarkers that can identify aggressive behavior and predict tumor recurrence after liver resection and transplantation.In HCC, the presence of microvascular invasion (MVI) is a histopathologic feature indicative of aggressive behavior (8). Previous studies have identified MVI as a major risk factor for early recurrence in the first two years after liver resection and transplantation (9). Precise identification of MVI involvement in patients with HCC is critical to develop treatment strategies and arrive at prognoses. Over the past decade, researchers have made persistent endeavors towards the preoperative prediction of MVI (10-12). Although several radiologic features on contrast-enhanced magnetic resonance imaging (MRI) and computed tomography (CT) images (such as tumor margin, internal arteries, and hypodense halos) are known PURPOSE We aimed to develop and validate a radiomics nomogram for preoperative prediction of microvascular invasion (MVI) in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). METHODSA total of 304 eligible patients with HCC were randomly divided into training (n=184) and independent validation (n=120) cohorts. Portal venous and arterial phase computed tomography data of the HCCs were collected to extract radiomic features. Using the least absolute shrinkage and selection operator algorithm, the training set was processed to reduce data dimensions, feature selection, and construction of a radiomics signature. Then, a prediction model including the radiomics signature, radiologic features, and alpha-fetoprotein (AFP) level, as presented in a radiomics nomogram, was developed using multivariable logistic regression analysis. The radiomics nomogram was analyzed based on its discrimination ability, calibration, and clinical usefulness. Internal cohort data were validated using the radiomics nomogram. RESULTSThe radiomics signature was significantly associated with MVI status (P < 0.001, both cohorts). Predictors, including the radiomics signature, nonsmooth tumor margin, hypoattenuating halos, internal arteries, and alpha-fetoprotein level were reserved in the individualized prediction no- CONCLUSIONThe radiomics nomogram, as a noninvasive preoperative prediction method, shows a favorable predictive accuracy for MVI status in patients with HBV-related HCC.

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Section: Discussionsupporting

confidence: 91%

A radiomics nomogram for preoperative prediction of microvascular invasion risk in hepatitis B virus-related hepatocellular carcinoma

Peng

Zhang

et al. 2018

Diagn Interv Radiol

153

124

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“…As such, in order to facilitate its inclusion into the selection process, a wide variety of studies are focused on optimizing methods of preoperative prediction of microvascular invasion using imaging modalities and other pre-transplant factors27282930404142. The results of the present study confirm that a combination of morphological tumor characteristics with serum alpha-fetoprotein concentration may be used for this purpose with moderate accuracy.…”

Section: Discussionsupporting

confidence: 57%

“…Due to the problem of intratumor heterogeneity, analysis of biopsy samples is inadequate for evaluation of microvascular invasion27. Several radiological studies have brought promising results, yet still either insufficient to provide a method of setting a definite pre-transplant diagnosis or requiring further validation27282930. Importantly, microvascular invasion is continuously reported to be associated with macroscopic tumor features, such as number and size, and serum oncologic markers31323334.…”

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confidence: 99%

Limitations of predicting microvascular invasion in patients with hepatocellular cancer prior to liver transplantation

Grąt

Stypułkowski

Patkowski

et al. 2017

Sci Rep

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Microvascular invasion (MVI) is well known to negatively influence outcomes following surgical treatment of hepatocellular cancer (HCC) patients. The aim of this study was to evaluate the rationale for prediction of MVI before liver transplantation (LT). Data of 200 HCC patients after LT were subject to retrospective analysis. MVI was present in 57 patients (28.5%). Tumor number (p = 0.001) and size (p = 0.009), and alpha-fetoprotein (p = 0.049) were independent predictors of MVI used to create a prediction model, defined as: 0.293x(tumor number) + 0.283x(tumor size in cm) + 0.164xloge(alpha-fetoprotein in ng/ml) (c statistic = 0.743). The established cut-off (≥2.24) was associated with sensitivity and specificity of 72%. MVI was not an independent risk factor for recurrence (p = 0.307), in contrast to tumor number (p = 0.047) and size (p < 0.001), alpha-fetoprotein (p < 0.001) and poor differentiation (p = 0.039). Recurrence-free survival at 5 years for patients without MVI was 85.9% as compared to 83.3% (p = 0.546) and 55.3% (p = 0.001) for patients with false negative and true positive prediction of MVI, respectively. The use of both morphological and biological tumor features enables effective pre-transplant prediction of high-risk MVI. Provided that these parameters are combined in selection of HCC patients for LT, pre-transplant identification of all patients with MVI does not appear necessary.

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“…However, the low sensitivity of 18 F‐FDG PET‐CT for detection of primary HCC was a major concern in the prestudy planning. In particular, well‐differentiated and early HCC may not be detected using FDG‐PET …”

Section: Discussionmentioning

confidence: 99%

“…In particular, well-differentiated and early HCC may not be detected using FDG-PET. 12,35 Yamashita et al 4 demonstrated that not only the presence of microinvasion such as portal venous, hepatic vein, bile duct infiltration, but also the presence of intrahepatic metastasis (satellites) is the best indicator of a poor prognosis after HR and transplantation.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative ultrasound for prediction of hepatocellular carcinoma biological behaviour: Prospective comparison with pathology

Santambrogio¹,

Claudia

Barabino³

et al. 2017

Liver International

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Background & Aims Preoperative prediction of both microinvasive hepatocellular carcinoma and histological grade of hepatocellular carcinoma is pivotal to treatment planning and prognostication. The aim of this study was to evaluate whether some intraoperative ultrasound features correlate with both the presence of same histological patterns and differentiation grade of hepatocellular carcinoma on the histological features of the primary resected tumour. Methods All patients with single, small hepatocellular carcinoma that underwent hepatic resection were included in this prospective double‐blind study: the intraoperative ultrasound patterns of nodule were registered and compared with similar histological features. Results A total of 179 patients were enclosed in this study: 97 (54%) patients (34% in HCC ≤2 cm) had a microinvasive hepatocellular carcinoma at ultrasound examination, while 82 (46%) patients (41% in HCC ≤2 cm) at histological evaluation. Statistical analysis showed that diameters ≤2 cm, presence of satellites and microinvasive hepatocellular carcinoma at ultrasound examination were the variables with the strongest association with the histological findings. In the multivariate analysis, the vascular microinfiltration and infiltrative hepatocellular carcinoma aspect were independent predictors for grading. Conclusions In patients with cirrhosis and hepatocellular carcinoma, the prevalence of microinvasive hepatocellular carcinoma is high, even in cases of HCC ≤2 cm. Intraoperative ultrasound findings strongly correlated with histopathological criteria in detecting microinvasive patterns and are useful to predict neoplastic differentiation. The knowledge of these features prior to treatment are highly desired (this can be obtained by an intraoperative ultrasound examination), as they could help in providing optimal management of patients with hepatocellular carcinoma.

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Preoperative Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for Prediction of Microvascular Invasion in Small Hepatocellular Carcinoma

Abstract: F-FDG PET-CT and AFP-L3 may be useful for predicting MVI in small HCC, and the combination of the 2 factors provided reliable assessment for selection of suitable hepatic resection and liver transplantation candidates.

Cited by 39 publications

References 32 publications

A radiomics nomogram for preoperative prediction of microvascular invasion risk in hepatitis B virus-related hepatocellular carcinoma

A radiomics nomogram for preoperative prediction of microvascular invasion risk in hepatitis B virus-related hepatocellular carcinoma

Limitations of predicting microvascular invasion in patients with hepatocellular cancer prior to liver transplantation

Intraoperative ultrasound for prediction of hepatocellular carcinoma biological behaviour: Prospective comparison with pathology

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